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Infection > HIV and AIDS > Flashcards

HIV and AIDS Flashcards

1
Q

5 Routes of transmission in HIV

A
  • Sexual transmission
  • Injection drug misuse
  • Blood products
  • Vertical transmission
  • organ transplant
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2
Q

Ethics: can you test an unconscious patient for HIV?

A

Yes - if you think its in their best interest. Negative result doesn’t affect insurance premium

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3
Q

Discuss the immunology behind HIV infection [4]
NB CD4 receptors also present on macrophages and monocytes, brain cells, skin, and more

At what CD4 count are most AIDs dx made
What is normal ref range of CD4 count

A
  • HIV infects and destroys immune system cells, esp CD4+ T Helper cells
  • CD4 count declines, HIV viral load increases
  • Increased risk of opportunistic infections caused by impairment of cell-mediated immunity (not ab-mediated immunity)
  • Also a B cell defect causing impaired ab production to new antigens > increased risk of infection with encapsulated bacteria esp strep penmoniae

CD4 count <200 - AIDs dx
500-1500 cells/mm^3

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4
Q

How many clinical stages of HIV is there?

A

4

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5
Q

Discuss clinical stage I of HIV? WHO

A

-Asymptomatic, persistent generalised lymphadenopathy (PGL)

|&raquo_space;Performance scale 1: Asymptomatic, normal activity

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6
Q

Discuss clinical stage II symptoms of HIV? WHO

4 minor mucocutaneous manifestations

A

-Weight loss (<10%)
-Minor mucocutaneous manifestations (seborrhoeic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheritis)
-Herpes Zoster
-Recurrent URTI
»and/or performance scale 2: symptomatic, normal activity

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7
Q

Discuss clinical stage III symptoms of HIV? WHO
3 unexplained systemic manifestations
5 infection-related manifestations

A
  • Weight loss (>10%)
  • Unexplained chronic diarrhoea (>1m)
  • Unexplained fever (intermittent or prolonged) >1m
  • Unexplained anemia or chronic thrombocytopenia
  • oral candidiasis
  • oral hairy leukoplakia
  • Pulmonary TB in last yr
  • severe bacterial infections
  • acute necrotising ulcerative stomatitis, gingivitis, periodontitis

> > and/or performance scale 3: bedridden <50% of day in last month

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8
Q

Discuss clinical stage IV symptoms of HIV? WHO

[6]

A

All HIV defining illnesses:

  • HIV toxoplasmosis
  • CMV disease of organ other than liver/spleen/LN
  • HSV infection
  • PML
  • Candidiasis incl. oesophague/trachea/bronchii/lungs
  • HIV encephalopathy
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9
Q

Difference between AIDs illness and HIV infection

A

Certain infections/tumours that develop due to weakness in immune system are classified as AIDS illness.
If asymptomatic infection, you have HIV infection only

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10
Q

Name some instances of HIV testing [3]
Name conditions when HIV testing should be offered?

[11 but know 7]

A
  • anyone requesting a test
  • Indicator illnesses (HIV related or defining diseases)-aseptic meningitis/encephalitis
  • At risk groups: patients with an STI (inflamed mucous membranes increase likelihood of transmission), MSM
  • GBS Guillian-Barre
  • transverse myelitis
  • dementia
  • unknown weight loss
  • hep b/c infection
  • lung cancer
  • seminoma
  • hodgkins lymphoma
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11
Q

What is the progression of HIV from initial infection? [5]

A 
>acute infection (seroconversion)
>Asymptomatic
>HIV related illnesses
>AIDS defining illness
>death
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12
Q

What are the symptoms of seroconversion (when HIV antibodies first develop)? [6]
May look like…….. and ………

A
  • flu-like illness
  • fever
  • malaise and lethargy
  • pharyngitis
  • lymphadenopathy
  • toxic exanthema

may look like glandular fever but negative EBV serology negative

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13
Q

Investigations [4]

How do we monitor? [2]

A

> p24 antigen usually positive 2-4 weeks post exposure
HIV-1 and -2 antibody at 4-6w
• Avidity test: tells whether infected in or out of last 4 months
• Resistance testing: for anti-retroviral resistant strains

Monitoring:
o Viral load: undetectable = untransmissable
o CD4+ count: should be 500-1000

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14
Q

What is the treatment for HIV? [2]

A

Highly active anti-retroviral therapy (HAART) = three drug combination (with at least 2 drugs from different groups)
- typically two nucleoside reverse transcriptase inhibitors (NRTI) and either protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor

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15
Q

Side effects of cART?
-3 SE of nucleoside reverse transcriptase inhibitors
-3 SE of non-nucleoside reverse transcriptase inhibitors
Requirements of treatment [2]

A
  • NRTI - marrow toxicity, lipodystrophy, neuropathy
  • NNRTI- skin rashes, hypersensitivity, drug interactions
  • Lifelong and adherence needs to be 90%
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16
Q

What classes of HIV medication are there? [5]

Give at least one example for each class

A

-Reverse transcriptase inhibitors
> NRTI - dines, bines, sines eg abacavir, tenofovir, zivovudine
> NNRT - nervapine, didanosine

-Integrase inhibitors -gravirs
> RALTEGRAVIR, ELVITEGRAVIR

-Protease inhibitors - navirs
IDINAVIR

17
Q

When should you consider commencing treatment for HIV?
Describe urgency of treatment in relation to CD4 count [2]
When to commence treatment in pregnancy?

A

> consider all patients at diagnosis regardless of CD4 count
if CD4<350 cells/mm3 encourage treatment
if CD4 <200cells/mm3 start asap
any pregnant woman - start before 3rd trimester

18
Q

What does life expectancy depend on in HIV sufferers?

A

How early treatment is started from point patient is infected

19
Q

Why do treatments fail? [4]

A
  • inadequate potency
  • inadequate drug levels
  • inadequate adherence (leads to viral mutation and resistance)
  • pre-existing resistance
20
Q

4 SE of protease inhibitors

1 SE of integrase inhibitors

A 
Protease Inhibitors SE:
Diarrhea
Lipodystrophy
Hyperlipidemia
Drug interactions

Integrase inhibitors SE:
Skin rashes

21
Q

Cosmetic procedures to treat lipodystrophy? [3]

A
  • facelift
  • liposuction
  • fillers
22
Q

How can HIV be prevented?

A
  • behaviour change and condoms
  • circumcision
  • treatment as prevention
  • Pre-exposure prophylaxis
  • Post exposure prophylaxis (PREP) for sexual exposure
23
Q

HIV complications in relation to CD4+ count

What are the 4 groups?

A

200-500 cells/mm3
100-200 cells/mm3
50-100 cells/mm3
<50 cells/mm3

24
Q

HIV complications in relation to CD4+ count: 200-500 cells/mm3 [4]

A
  • Oral thrush
  • Shingles
  • Hairy leucoplakia
  • Kaposi’s sarcoma
25
Q

HIV complications in relation to CD4+ count: 100-200 cells/mm3 [5]

A
  • Cryptosporidiosis
  • Cerebral toxoplasmosis
  • Progressive multi-focal leukoencephalopathy
  • PJP pneumonia
  • HIV dementia
26
Q

HIV complications in relation to CD4+ count: 50-100 cells/mm3 [4]

A
  • Aspergillosis
  • Oesophageal candidiasis
  • Cryptococcal meningitis
  • Primary CNS lymphoma
27
Q

HIV complications in relation to CD4+ count: <50 cells/mm3 [2]

A
  • CMV retinitis (retinal haemorrhages, necrosis and cotton wool spots; pizza appearance)
  • Mycobacterium avium intracellulare
28
Q

Diarrhea and HIV

Causes [5]

A 
HIV enteritis
Cryptosporidium
Mycobacterium avian intracellulare
CMV
Giardia
29
Q

What is PJP prophylaxis?
Dose and frequency
Indication

A

CO-TRIMOXAZOLE 480mg OD

o Ind: CD4+ count <200

30
Q

What is PrEP

A

Truvada

Tenofovir + EMTRICTITABINE

31
Q

Cryptococcus infection in HIV
Presentation [2]
Investigation [2]
Mx

A
  • headache, fever, malaise, N&V
  • focal neuro deficit
  • CSF has high opening pressure and is India ink test +ve
  • CT shows meningeal enhancement with cerebral oedema
  • mx is IV AMPHOTERICIN
32
Q

PML
Presentation [2]
Ix

A
  • widespread demyelination due to oligodendrocyte infection by JC virus
  • subacute onset with behavioural changes, speech, motor and visual impairment
  • CT shows single or multiple lesions with no mass effect that don’t usually enhance (MRI better)
33
Q

Primary CNS lymphoma is a neuro complication of HIV
Association
CT findings
Mx [2]

A
  • assoc. w/ EBV
  • CT shows single homogenous enhancing lesions (thallium SPECT +ve)
  • mx is steroids and chemo (METHOTREXATE)
    +/- whole brain RT (surgery sometimes considered for low grade tumours

Infection (20 decks)

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